SCHOLARSHIP APPLICANT RECOMMENDATION FORM

CHARACTER REFERENCE FOR GDHA SCHOLARSHIP APPLICANT

NAME OF APPLICANT: __________________________________________________

The above applicant has applied for a scholarship given by the Georgia Dental Hygienists’ Association and has given you as a reference. Please appraise the applicant in respect to those qualities which you have been in a position to evaluate. Your report will be held in strict confidence.

REFERENCE NAME: _________________________________________________

Position or business: ______________________________________________________

In what capacity and for how long have you known the applicant?

________________________________________________________________________

Please rate the applicant in the following areas:

ADDITIONAL COMMENTS (Additional information and/or comments that will be helpful in evaluating the applicant):

Signature: _________________________________________ Date: ________________